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I’m worried about someone…

 

Someone close to me has experienced a suicide loss;

Introduction: When someone we care about is grieving, it is natural to feel helpless. It can be even more difficult following a suicide or drug overdose death. If you have a friend or loved one who has been affected by suicide, it might be hard for you to know how to help or what to say. You do not have to be a mental health professional to be supportive and to make a difference. In fact, care from family or a friend is especially helpful and comforting for someone going through this type of loss.

Let them know you care: Just acknowledging the situation and keeping in touch is a meaningful way to offer your support. There may be times when your friend or loved one needs space to grieve alone, but it can be incredibly comforting and reassuring for them to know that you are “there” for them and that you care. This is a time to follow cues and to do what seems most comforting for the person who is grieving; it is a time to offer care, support and compassion when they need it and to be patient and understanding if they need space from you.

Listen with acceptance: Everyone experiences grief differently and there is not a single “right way” to process loss. You cannot fully understand what your friend or loved one is thinking and feeling unless you ask them and listen to their answers. This might mean that your support involves much more listening than speaking. When you do speak, focus on asking questions that create more opportunities for them to process their grief. For example, “How have you been managing since [name] died?” “How have you been feeling?” Try to maintain a balance between asking a few simple questions and sharing times of peace and silence; be aware that too many questions may be overwhelming.

Be patient: People grieve at different paces – it is really helpful to them when you are patient and non-judgmental about the way they are grieving and the time it takes for them to go through this painful process. You may notice that their emotions are unpredictable, or their focus on the loss comes and goes at unexpected times. Try to remain steady and avoid expectations or jumping to conclusions about how they feel. Avoid taking things personally – there can be times when your friend or loved one wants to be left alone, or doesn’t seem to be attentive to your needs, or snaps at you for no reason at all – let it go, be patient; this is part of being in a supportive role for someone who is grieving.

Offer practical support: “I am here for you if you need me.” “What can I do to help?” It is good to offer help and assistance to someone who is grieving, but if your loved one doesn’t know how you can help or isn’t able to ask for something specific, it is good to help without being asked. Bring them their favorite take-out food, clean up their room or make their bed, bring flowers, do their laundry, take out the trash, etc. You might be surprised how big a boost it is when people take care of the small things for a grieving friend.

Keep these things in mind:

  • Grief can last longer than a few weeks or months. Remember that there is a lot of attention and support immediately after someone dies – the grieving process goes on long after that, so reaching out months later is very comforting and gives the message that the loss and pain have not been forgotten.
  • Grieving after a suicide can result in unexpected and conflicting feelings (including anger, shame and confusion). This is common for those who have lost someone to suicide (or drug overdose) and those supporting them.
  • Avoid giving advice, as this is rarely helpful. If you want to make helpful suggestions, start with “Have you thought about trying….” or “I wonder if it would be helpful to…….”
  • Allow your friend or loved one to express any emotion that they are feeling — cry, laugh, break down, become angry – these are all normal emotions during grieving. Remember that it is ok for you to show your sorrow or grief too.
  • Try to avoid comments such as, “I know how you feel,” “They are in a better place,” or “It’s time to move on.” It is best not to talk about yourself or to make impersonal, general statements even when you mean well when you say them.
  • Anniversaries, holidays and birthdays can be particularly difficult for survivors. Acknowledge how difficult these occasions might be for your friend or loved one and perhaps plan to spend some time with them on those dates.

Connect them to resources:

Talking to a professional after losing someone to suicide may help with processing and managing feelings of grief and sadness. For some people, group therapy and support groups for grief and grieving can be very helpful and can usually be found in your community and/or college campus.

Encourage your friend or loved one to seek help when intense feelings of depression, isolation, confusion and anger do not decrease over time. Suicide survivors are also at risk of having their own suicidal thoughts.

It is especially important for your friend or loved one to seek professional support if they exhibit the following:

  • Prolonged grief and sadness
  • Intense emotions that do not decrease over time
  • Symptoms of distress that reach the point where they are no longer able to function at their usual level (e.g., can’t go to school or work; poor academic or work performance)
  • They begin to cope in unhealthy ways (e.g., using alcohol and other drugs to numb feelings about what has happened)
  • Thoughts of self-harm

There is no set path or timeline for grieving, but in the typical grieving process, the heavy sadness and intense feelings of loss should improve as the days and months go on. Remind your friend or loved one that seeking professional help for prolonged, intense grieving is a sign of courage and strength.

Take care of yourself: Supporting a person who has lost someone to suicide can be emotionally taxing. You will be best equipped to offer support if you are also taking care of yourself. If you are in a support role, take occasional breaks, take care of your body with exercise, adequate sleep and good nutrition and take time to talk to a friend, family member or counselor about your own feelings.

My child has lost someone to suicide;

Introduction: If your child has been affected by the loss of someone close to them by suicide, it might be difficult for you to know how to best comfort them and help them to navigate their grief. While it is natural to feel helpless, know that you do not have to be a mental health professional to support them through their loss. Here are some practical and concrete ways to understand and help your child during this challenging time.

Communicating with your child about a suicide: Suicide is complex and difficult for adults to understand. So, of course, it can be daunting to try to explain it to a child. How you talk with your child about suicide will be different depending on their age – the key is to try to be as honest and clear as possible. If your child asks you what suicide is, you can let them know that suicide is when someone intentionally takes their own life. Just as people die from diseases like cancer or from car accidents, some people have serious brain illnesses that cause them to die by suicide. If your child wants more detail, use your discretion to help them understand as much as is age appropriate. For older children and teens who ask “Why?” it is ok to let them know that you don’t understand it completely yourself. Sharing your struggle to make sense of the loss and how you are coping with your grief can be helpful to older children. For guidance on how to best address a death by suicide with your child, consult with your family doctor or your child’s pediatrician.

Be honest and tell them what you know about loss: Let your child know that there are no right or wrong ways to experience a significant loss and that everyone grieves differently. You can let them know that grief does not last for a set amount of time. It will be important to tell them that, while there is not one thing that will take their sadness away, the loss will get easier to deal with over time. Telling them about your experience dealing with grief can go a long way to normalizing their painful feelings.

Children and grief: As children grow and mature, they develop new and more refined ways of understanding their experiences. Children of different ages will understand a significant loss based on their developmental stage at that time. Thus, it is natural for your child to develop new ways of understanding and talking about a suicide loss as they mature. Be prepared for that, and do not be surprised if they ask similar questions repeatedly as they grow older. This is their way of making sense of the loss.

Importance of routine: Encourage your child to continue participating as much as possible in their regular routine and the things that they enjoyed before losing their friend or family member. Also, encourage them to keep being themselves and behaving like a child or teenager. Sometimes people feel guilty having fun and experiencing pleasure after a loss. Let your child know it is okay, over time, to have fun or feel happy. Even if they don’t feel like their usual self for a while, it will help them to re-engage in what they know as normal. Parents should also model this behavior for their children by trying to get back to life routines as appropriate.

Need for stability: In the wake of a suicide, a child will need to reestablish a sense of stability and security. Thus, it is important that parents convey a comforting and reassuring tone and demeanor, and a sense of strength in this difficult time. Keep in mind this may be especially challenging in the face of a suicide since, as a parent, you may also be sharing your child’s sense of sadness and distress. This is why it is very important for you to seek support from other adults so that you can be present for your children. Nevertheless, with older teens, it is okay for them to recognize that you are also sad about this loss — as long as they see you coping in healthy ways.

Peer support:

If your child experiences a suicide loss that affects their group of close friends, consider coordinating a gathering of their friend-group, with the presence of parents/adults and, if possible, a school counselor. This provides an opportunity for your child and his or her friends to support one another, and also a chance for the adults to gauge how the youth community is managing its loss.

Memorials at school or on a college campus may seem like a good way to help students cope with feelings of loss and to honor the person who has died. Before such an event is considered, it may be helpful to remember that the impact of memorials may not always have the desired effect. If you are thinking about holding a school memorial or erecting a permanent memorial for a young person who has died by suicide, there are numerous factors to review before you plan.

  • Memorials may act as a catalyst for copy-cat or contagion suicides; teens who are at risk for suicide are vulnerable when they see that someone else’s suicide death has brought mass attention and an outpouring of sympathy and strong emotions in the deceased person’s honor
  • Memorial services can send the message that suicide is an acceptable choice for solving problems

The SPRC guidelines suggest alternative memorial activities such as donating money to a cause meaningful to the deceased student, or volunteering in honor of the friend or loved one who has died.

Self-care for your child: It is also important to encourage your child to be healthy and take care of themselves. Support your child’s maintenance of healthy habits, such as eating well, getting a good night sleep, exercising and being careful of substance misuse. You should also encourage and teach your child to use healthy stress-management strategies.

Self-care for parents: Supporting your child through his or her grief, after losing someone to suicide, can be emotionally taxing. To best care for your child, it is essential that you take care of yourself. It can be distressing to see your child suffering, and you may also be dealing with your own grief around the loss. Also, be mindful that parents are likely to experience discomfort over the loss of someone who is as young as their child and it will be important for you to work through these feelings. Make sure that you can process your feelings and concerns with someone (such as a friend, family member or counselor).

When to seek help:

When you notice significant and prolonged changes in your child’s behavior, consider seeking out further support from a professional. Remember that you know your child better than anyone and that you are best equipped to notice significant and prolonged changes in their behavior or emotional state.

Some of these changes might include:

  • Loss of interest in previously enjoyed activities
  • Alcohol, tobacco or other drug use
  • Avoidance of emotions
  • Withdrawal from friends and family
  • Significant changes in sleep or eating
  • Increased difficulty with school or work
  • Marked changes in their self-care
  • Preoccupation with death or self-harming impulses/behavior. If your child is talking or joking about their own death or about self-harm, it is important to reach out for help as soon as possible

I’m concerned about someone who may have an alcohol or substance use problem;

Introduction: Many, but not all, young adults and adults drink alcohol as part of their social life. However, some people drink or use substances excessively – they use substances or drink excessive amounts of alcohol in a very short period of time, or they drink or use substances frequently throughout the week. Excessive drinking and substance use usually interferes with school or work performance, disrupts personal relationships and has a negative impact on a person’s health. If something in your gut tells you that someone you know has a problem with using substances or drinking too much, it is good to follow your instincts and encourage that person to get help.

Next are some things you might observe if a person you know has a problem with drinking or substance use.

How they may look:

  • They may look tired or worn out
  • They may stop taking care of themselves – they don’t bathe or pay attention to their clothing or appearance
  • Flushed, red face
  • They may seem “out of it” or unable to focus
  • They may have bruises or other minor injuries on their body

How they may act or behave:

  • Academic and work performance slips
    • They begin to miss classes or days at work
    • They don’t meet deadlines for school work or work assignments
    • They are chronically late for appointments
  • Sleeping habits change – sleeping all day, not sleeping at night
  • Their mood becomes irritable, grumpy, sad; can suddenly be upbeat and “hyper”
  • Relationships and friendships become tense or closed off
  • Activities and things that used to give them pleasure no longer interest them
  • They may have a new set of friends or acquaintances
  • They might get anxious, tense, defensive or angry when someone talks to them about their substance use
  • They frequently use substances to the point of getting sick (vomiting or passing out)
  • They do dangerous or risky things without seeming to care (or often do things while partying that they subsequently regret)
  • They may not seem like the person you used to know

How they may talk or what they may say:

  • “I need a drink before we go out.” (drinking to help diminish social anxiety)
  • “Most kids drink (or use substances) as much as I do.”
  • “It’s just partying, it’s not a problem.”
  • “I only do it once or twice a day.”
  • “I don’t remember how I got home last night.” (blackout)
  • “I feel sick.”
  • “I keep having accidents and I don’t know why.”

What you might see on social media:

  • References to drug use
  • Posts that show lack of judgment or inappropriate behavior
  • Inappropriate photos

What to do:

If you think someone you know has an alcohol or substance use problem

  • Listen (really, listen) if they are willing to share their worries with you
    • Try to avoid judgment or jumping to conclusions
    • Don’t feel like you have to have all the answers
    • Be comfortable with silence
  •  Let them know you are concerned
    • Tell them what you have noticed and why it worries you
    • Suggestions on how you can start this conversation include:
      • “I’m worried about you because you seem…” (e.g., to be drinking a lot, angry when I try to stop you from using substances, etc.)
      • “It concerned me when you said…” and be specific about what you heard
      • “Do you want to talk about it?”; “What can I do to help?”
  • Be there for them
    • Sometimes just knowing that someone cares and is there for them is all someone needs to get through a difficult time
    • Let them know that it is possible to feel better and they are not alone
    • Offer to help (for example, make their bed, straighten up their desk, help with laundry, or pitch in with chores, etc.)
    • Try to do activities that are substance free – go to a museum or movie, play sports, hang out with friends in a public place, etc.
    • Someone may not be ready to follow your advice and seek help. Continue to revisit the issue over time so they know you will support them and that help is available whenever they are ready

Get additional help when:

It is time to get additional help for someone you think has an alcohol or substance use problem when:

  • They say they feel out of control and can’t stop
  • They are using substances or drinking every day and can’t stop
  • They are experiencing “blackouts” (a period of memory loss)
  • They are making decisions that will harm them or put others in harm’s way
  • Your gut tells you that something is really wrong

A friend of mine seems really down and may be depressed;

Introduction: If you are concerned that someone you care about is experiencing depression, you have probably noticed changes in that person’s mood, thoughts, feelings and the way they act around you. It is likely these changes have lasted longer than you would have expected (not just a bad day, or a bad mood) and have caused you concern.  Though there are many specific ways to tell that someone has depression, the first thing you may notice is that you have a feeling in your gut that someone you know is struggling and down. It is good to follow your instincts and encourage anyone you are concerned about to get help.

Check out the following cards for some things that you might observe if a person you know is depressed.

How they may look:

  • There may be a change in how they take care of themselves – you may notice they are not showering, changing clothes or taking an interest in make-up or haircuts, etc.
  • They may look down or sad, or even show no emotion at all. They could also appear angry or anxious.

How they may act or behave:

  • They may sleep for hours and yet still act and feel tired.
  • Some people may cry a lot, but others may seem very irritable or angry when they are feeling sad (this is particularly the case for men).
  • They may overreact to things – get angry, sad or offended easily.
  • They may no longer want to do the things that they used to enjoy doing.
  • They don’t want to be with friends or family and seem to prefer to be left alone.
  • They may lose their appetite and can’t eat or may eat more than usual.
  • They can’t remember things, they have a hard time making decisions and they can’t concentrate on conversation, TV, reading, social media, studying, or simple tasks, etc.

How they may talk or what they might say:

You may notice that they are often saying things like:

  • “I’m totally worthless.”
  • “I just can’t take it.”
  • “What’s the point?”
  • “I wish I could just not wake up.”
  • “I’m messing everything up in my life.”
  • “I’ve let people down.”
  • “I don’t feel well.” (or other physical complaints such as a headache or stomach ache)

What you may see on social media:

  • Posting comments such as “I hate myself,” or “I suck at everything.”
  • Posting dark poetry or quotes, disturbing songs or videos
  • Using hashtags that are connected to worrisome trends
  • Using sad, distressed emoticons or emoticons of destructive things such as guns, knives, etc…

If you think someone you know is depressed:

  • Let them know you are concerned
  • Suggestions on how you can start this conversation include:
    • “I’m worried about you because you seem…” (e.g., really down or sad a lot of the time, to be spending most of your day in bed and are missing all of your classes, etc.)
    • “It concerned me when you said…” and be specific about what you heard
    • “Do you want to talk about it?”; “What can I do to help?”
  • Tell them what you have noticed and why it worries you
  • Listen (really, listen) if they are willing to share their worries with you
    • Try to avoid judgment or jumping to conclusions
    • Don’t feel like you have to have all the answers
    • Be comfortable with silence
  • Be there for them
    • Sometimes just knowing that someone cares and is there for them is all someone needs to get through a difficult time
    • Let them know that it is possible to feel better and they are not alone
    • Offer to help (for example, make their bed, straighten up their desk, help with laundry or other chores, etc.)
    • Someone may not be ready to follow your advice and seek help. Continue to revisit the issue over time so they know you can support them whenever they are ready

It is time to get additional help for someone who you think is depressed when:

  • Their emotions or behaviors become too intense
  • Their difficulties are lasting too long (weeks) without a break
  • Their struggles disrupt their daily life
  • Your gut just tells you something is not right

I want to help someone who is struggling;

Introduction: The fact that you care enough to take the time to read this and that you want to support someone in distress is an important first step in being helpful. If you want to help someone who is struggling, it is important to keep your sights on the fact that caring, checking in and being there over time will make an important difference. It can really help people to know that they are not alone. Asking about problems in a caring way is supportive and almost never makes things worse. Even if someone isn’t ready to talk about the sources of their distress – the fact that you reach out will communicate to them that you are there whenever they are ready.

Next are some additional things to keep in mind.

Compassionate concern is very helpful:

  • If someone is in distress, they may need reassurance. Let them know that it is possible to feel better and they are not alone
  • Let them know it is ok to ask for help and doing so is a sign of courage, strength, and good judgment
  • Listen to them (really listen) – be comfortable with silence if that is what they need
  • If something doesn’t make sense, ask about it, don’t try to fill in the gaps with your own thoughts or words or jump to conclusions
  • Try to be patient and non-judgmental about how and what they might share with you
  • Don’t feel like you have to give advice or know all the answers. Just sitting with someone as they try to navigate their distress can be very powerful
  • Suggestions on how you can start this conversation include:
    • “I’m worried about you because you seem…” (sad, withdrawn, etc.)
    • “It concerned me when you said…” and be specific about what you heard
    • “Do you want to talk about it?”; “What can I do to help?”
    • “It’s okay if you don’t want to talk to me, but I would feel better if you would talk to someone.”

Connecting someone to resources can be a first step in getting help:

In some cases, you may feel like your friend or loved one would benefit from therapy or treatment. If this is the situation, it is preferable to be direct about your concern and open to finding a way to ease their anxiety about seeking help.

  • Convey your belief that treatment can help.
  • Share a story about a time that you or someone you know struggled and how professional support helped.
  • Offer to look online with the person to help find some good treatment options.
    • If you are on a college campus – offer to help make an appointment, or to go with them to the counseling center.
    • If they are not in school, offer to help find a counselor, make an appointment and even go with them for the first visit
  • Make it clear that you will follow-up to find out how it went and what their plan will be.
  • Someone may not be ready to follow your advice and seek help when you first bring it up. Continue to revisit the issue over time so they know you will support them whenever they are ready.

Asking about suicidal thoughts:

  • If you have any concern that the person may be having thoughts of self-harm, there is no reason to avoid asking about it directly. You won’t plant the idea of suicide into a person’s thoughts by mentioning it. The benefits of asking someone if they are having suicidal thoughts greatly outweigh the risks.
  • Educate yourself about signs that someone may be at risk for suicide if you are unsure.

If your instincts tell you that someone is in crisis and needs immediate help:

  • Stay with them while you assist them in getting help.
  • Call 911.
  • You can also Text START to 741-741 or call 1-800-273-TALK (8255), you will be connected to a skilled, trained counselor at a crisis center.
  • Or bring your friend or loved one to the nearest Emergency Department.
  • If you are on a college campus, call public safety or go to the student health center.

I’ve offered my help to someone, but they don’t want to accept it;

Introduction:

Sometimes when we express concern, people don’t want to or are not ready to accept our help. If they say no when you offer help it could mean a few things:

  • They may not believe there is a problem
  • They may be worried that facing the problem will make it worse
  • They may be concerned about other consequences
  • They feel threatened or judged
  • They are not comfortable opening up to you about the problem but might be more receptive to hearing it from someone else.
  • The timing of your conversation is not right

What you can do:

If you feel like your first attempt to discuss your concerns is unsuccessful and your gut tells you it’s not an emergency situation, there are several things you can do:

  • Try offering alternatives – “I would feel so much better if you would agree to talk to someone else if I am not the right person for this.” And if the timing is off, you might offer to talk again, “if this isn’t a good time, I am open to talking about this when it’s good for you.”
  • Offer to help them connect to professionals – health center, counseling services, doctor, or any other trusted counselor
  • Urge them to talk to loved ones or family
  • Tell them you will keep in touch about your concerns and that you will keep the lines of communication open, checking in regularly

It’s time to get help when:

If you are particularly concerned, your gut tells you not to “drop it” or if you feel that someone you know is in harm’s way, you should:

  • Get advice about the situation from someone you trust – be specific about your concerns
  • Tell an RA, teacher, counselor, parent, coach, or other trusted adult about your concerns and ask them to help
  • Get help as soon as possible when a person is a danger to himself or others – this is serious and best handled by trained professionals such as emergency services, the counseling center, campus police, a family doctor, etc.

If someone is having an emergency and refuses help, take the situation very seriously and get yourself or them connected to help as soon as possible: call 1-800-273-TALK (8255), text START to 741-741 or call 911.

I’m worried about someone, but I’m not sure if there’s cause for concern;

Introduction: Maybe it has taken a friend longer than usual to return a call or text. Perhaps you ran into them, and something just seemed off. You aren’t sure if it’s a big deal, but something in your gut tells you to be concerned. Is this just your friend having a bad day, or is there something more serious going on?

It is common to have periods of difficulty and emotional struggle throughout our lives – adjustment challenges can be a normal part of life. At times, these difficulties are no more than brief challenges that are not worrisome. However, in some instances, common adjustment issues can become overwhelming or bring about serious problems that require help. So as you think about your friend or loved one, you may be wondering, “How can I tell if there’s serious cause for concern?”

Some common signs include:

Some common signs* that someone is experiencing a significant challenge include:

  • Excessive worry
  • Feeling sad or acting irritable
  • Problems with concentration or memory
  • Extreme variability in mood
  • Avoiding social activities or interacting with friends
  • Changes in sleeping or eating habits
  • Changes in energy level
  • Changes in appearance/hygiene
  • Abuse of substances (such as alcohol or drugs)
  • Talking about suicide

What you can do to try to help:

  • Reach out and let them know you are concerned
  • Tell them what you have noticed and why it concerns you
  • Listen (really listen) if they are willing to share their feelings or talk about their problems with you
    • Try to avoid being judgmental and avoid jumping to conclusions
    • Be comfortable with silence – don’t push them
  • Tell them you know it is possible to feel better
  • Let them know they are not alone – be there for them
  • Keep lines of communication and connection open – they may not be able or willing to hear your concerns or take your advice the first time you bring it up. Make sure they know you will support them and that help is there when they are ready.

It may be time to get additional help when:

Things you notice that may indicate it’s time to get help for someone:

  • Problems are severe or intense, last a long time or keep getting worse
  • Difficulties seem to be repeating themselves
  • They say that they are overwhelmed and can’t help themselves
  • Challenges are interfering with normal (day-to-day) functioning
  • The usual ways of dealing with things don’t seem to be working
  • Comments suggesting thoughts or impulses to self-harm or harming others are present:
    • “I give up.”
    • “I wish I could just not wake up.”
    • “I could just kill my teacher.”
    • “My aunt has a gun in her dresser.”
    • “I saved up a bunch of pills from when my Mom had surgery.”
  • You can’t put your finger on it, and it isn’t clear what exactly is going on, but your gut tells you something really isn’t right